Reviewing treatment options for patients with uveal melanoma

This guideline reviewed treatment options for patients with newly diagnosed uveal melanoma.

The uvea is the middle layer of the eye. It is made up of the iris (the colored part of the eye), the ciliary body (a muscle in the eye), and the choroid (a layer of tissue in the back of the eye). In uveal melanoma (UM), tumors develop from the colored cells in the iris, which give color to the eye. It is one of the most common types of eye cancer in adults.

It is important to review the treatments for patients with newly diagnosed UM.

For patients with localized UM that has not spread outside the eye, treatment options depend on tumor size and how close the tumor is to the optic nerve. The optic nerve is at the back of the eye and sends electrical impulses from the retina to the brain so that we can see. Damage to this nerve can impair vision.

Radiotherapy remains a standard treatment for localized UM, regardless of tumor size. However, for patients who are not good candidates for radiation, laser therapy may be recommended. Other treatment options depend on tumor size. For patients with small, thin tumors (less than 2.5 millimeters thick), laser therapy may be recommended.

For patients with thicker tumors (2.5 to 10 millimeters thick), laser therapy or resection (removing the tumor with surgery) may be recommended. Enucleation may also be considered for patients with severe glaucoma or blind, painful eyes. This involves the removal of the whole eye and insertion of an implant.

For patients with larger tumors (more than 22 millimeters in diameter), particle beam radiotherapy is preferred. This type of radiotherapy exposes the tumor to radiation with protons or other ions. It may also be recommended for patients with tumors that are too close to the optic nerve. Enucleation is another option.

For patients with UM that has spread to other parts of the eye, enucleation (surgical removal of the eye) followed by radiotherapy is recommended. For patients with thin tumors, radiation alone may also be used. For patients with cancer that has spread into the eye socket, orbital exenteration may be recommended. This involves the removal of the eye and its surrounding tissues, such as the eyelids.

For patients with cancer that has spread to other parts of the body (metastatic), treating the primary tumor in the eye may be considered. The authors suggest that if the tumors outside the eye are being treated, the primary tumor should also be treated.

This article reviewed treatment options for patients with newly diagnosed uveal melanoma.